Clin Med 2 Flashcards
when taking bp, initial measurements should be taken on which arm? nml diff = 5-10mmHg, but what’s abnl?
both. 10-15mmHg -> subclavian steal syndrome, aortic dissect
when to do more invasive testing for bp? when giving meds, how much bp reduction should you aim for?
refractory HTN, sus for secondary causes, new sudden onset. reduce slowly -> 5-10mmHg/wk
what’s cyanosis? physio vs patho?
blue skin & mucosa d/t deO2/reduced hgb. when cold, blood = shunted to internal organs vs blood flow obstruction from a/v thrombosis, embol, vasospasm, external compression
what 3 sxs determine thrombosis?
Virchow’s triad: impaired blood flow/stasis, vasc endothel dmg, hypercoag (acquired ab, mutations, iatrogenic)
primary vs secondary hemostasis
phospholipase frees arachidonic acid from cell mem –> arach acid to TX –> degran –> PLT bind to vasc wall via collagen, vWF vs coag cascade, thrombin making fibrin clot, fibrinolytics to stop making clot
L vs R side heart fail PE findings. aortic stenosis PE findings
rales, S3, displaced PMI vs ascites, edema, JVD. systolic murmur, abnl pulses
LV dysfxn vs RV infarct
cardiogenic shock -> inc HR for dec CO, rales & edema –> IABP, impella; diuretics, other antiHTN; inotropic/pressor, DA/dobutamine, dobutamine/phenylephrine; ECMO/LVAD vs no rales but HoTN –> lg vol fluid, reperfusion, time
inf infarct = ischemia of? complete AV block occurs from?
SA node -> sinus brady, AV node -> AV block. ant MI < inf MI < pre-existing RBBB + LAFB
most serious electrical complication of ACS is? do we tx accel idio vent rhythm? how to avoid these complications? how to tx brady vs tachycardia?
vtach/vfib -> defib & CPR, amiodarone. no. be prepare, correct electrolytes, keep hgb in optimal range. atropine, pace vs BB, CCB
what to do for initial eval for VHD? additional eval?
H&P: EKG & CXR -> heart size, pulm congst, intrinsic lung dz, calc of aorta or pericardium; TTE = most accurate way to assess VHD. TEE for mitral or prosthetic valve, intracardiac mass; cardiac cath for intracardiac & pulm pressure, valve severity, hemodynamic response to exer & drugs; CMR, PET-CT, exer test
what are the 4 preprocedural tests you need before valve intervention?
dental exam to prevent bacteria; CT coronary angio for coronary aa anatomy; CT periph for fem access for TAVI; CT cardiac for suitability of TAVI
stage A vs B vs C vs D of VHD
at risk vs progressive -> mild/mod, asx vs asx severe; C1 = L/RV compensated, C2 = L/RV decompensated vs sx severe
when to follow up for pts w/ VHD?
if no new/changing sxs -> rpt TTE
Stage B = f/u q 3-5y for mild, 1-2y for mod
Stage C = f/u q 6-12mo x/ mitral sten -> 1-2y
managing pts after valve intervention: procedure complications vs management vs sxs after intervent
paravalvular leak, bleed, stroke vs endocarditis prophylaxis, routine echo vs INR if VKA anticoag, assess valve fxn
img after valve intervention: mechanical vs bioprosthetic vs mitral valve repair
baseline echo (tradeoff = lifelong anticoag like warfarin) vs baseline echo, 5-10yrs post op, then annual (doesn’t last long) vs baseline echo, 1 yr, then 2-3yrs (clot can form in mitral valve)
